The patient population

Changing population demographics in the UK mean the prevalence of neurodegenerative diseases and many other neurological disorders is increasing. Prompt diagnosis and intervention can help to identify the likely health and social impacts of the disease at an early stage, and thereby avoid hospital admissions, and reduce the negative effect on quality of life for both patient and carer where possible. 

Improving the management of the more common disorders that affect younger people, such as migraine and epilepsy would also have a major public health impact. Migraine is ranked globally as the seventh most disabling disease among all diseases (responsible for 2.9% of all years of life lost to disability) and the leading cause of disability among all neurological disorders. It is estimated that the UK population loses 25 million days from work or school each year because of migraine. Severe migraine attacks are classified by the World Health Organization as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis.

The following datasets on the prevalence of neurological diseases in the population are also useful sources of information on the local population for planning services:

Prevention of disease

Historically, the specialty of neurology has been specifically concerned with the diagnosis of neurological disorders. During the last 20–30 years there has been a revolution in the treatment of many conditions, some of which were previously considered untreatable (eg stroke and multiple sclerosis). Neurologists are now turning their attention to health promotion and disease prevention.

Examples include:

Planning effective services

Despite an overall increase in the commissioning of neurology services, there continue to be low numbers of neurologists compared with other developed countries. There is also a need for seamless commissioning of the whole patient pathway, regardless of setting. Thames Valley Strategic Clinical Network has recently produced a neurology commissioning brief for community neurology services, which provides information on delivering high-quality integrated services.

Referral to treatment targets have distorted services so that although waiting times for new patient referrals have reduced, there is a disincentive for services to see follow-up patients, which negatively impacts on the care of people with long-term neurological conditions (see the Association of British Neurologists Commissioning Toolkit 2016, opens PDF, 413.29KB)

Large variations in the quality of commissioning of neurological services among clinical commissioning groups were highlighted in the Neurological Alliance’s report The Invisible Patients. A recent progress review (opens PDF, 574.59KB) of services to people with neurological conditions by the Public Accounts Committee acknowledged the inadequate commissioning of neurology services,

There also needs to be an improvement in the commissioning of acute neurology services as identified in a recent survey (opens PDF, 254.46KB) by the Association of British Neurologists.